Supervision And Evaluation Of The Effect Of National Essential Medicine System In Township Hospitals In Jiangsu Project Counties

Objective This paper analyses the changes in economic operation, medication rationality, and basic medical services behavior, including the number of service, efficiency and cost, of the township hospitals in six project counties before and after the implementation of national essential medicine system, in order to find out the gap between expectations and implementation effect of the national essential medicine system, further analyzing reasons for the gap generated. And to investigate the factors which affect the implementation of essential medicine system, put forward policy proposals to further improve the implementation of essential medicine program and provide suggestions for deepening the reform of the medical and health system.Methods Related statistical data and information was collected from Health Bureau of six counties and Health Statistics Yearbook. Vertically and horizontally, this study compared and analyzed the indexes of availability of basic health services, financial balance and human resource of all township hospitals in the six counties from2009to2012. Two counties were selected randomly, using stratified sampling method, according to the operating conditions of best, medium and worst-layered, a township health institution was extracted from each project county. This study extracted200outpatient prescriptions of two years from the above six samples township hospitals, a year before the implementation of essential medicine program and one year after that. Results Comparing the implementation of the essential medicine system in the township hospitals of the six countries in2012with that in2009:①the total revenue, the government reimbursement, the total business revenues, and the health services revenues of country average showed an upward trend. The counties’average total revenue increased by67.89%, the counties’average government reimbursement increased by542.55%, the counties’ average total business revenues increased by11.36%, and the counties’ average health services revenues increased by49.23%. The percentage of the medicine income within the total income declined, but still at a high level over51%. The counties’ average total expenditure increased, within which the counties’average business expenditure, the medical expenditure and the medicine expenditure all increased. Based on the expenditure structure, the medical expenses were increasing rapidly. The counties’ average total revenues balance decreased. The business income and expenses losses seriously. The medicine balance declined dramatically. The counties’ average total liabilities rose from35.562million yuan to62.856million yuan.②The amount of basic health services increased. The outpatient and emergency visits increased by33.79%. The discharges increased by4.39%. The cost of basic medical services declined. The average outpatient expenses and medicine expenses decreased by10.19%and21.43%respectively. The average hospitalization expenses decreased8.3%, the average hospitalization medicine expenses decreased19.92%. The efficiency of the basic medical services decreased.③Total number of employees, personnel expenses, the ratio of personnel expenses to revenue, the ratio of personnel expenses to operating expenses, the per capita personnel expense and average revenue per worker were increased.④The average number of drug varies per prescription, the antimicrobial usage, the hormone usage and the failure prescription rates declined.Conclusion In spite of the efficacy of the essential medicine system gained in the township hospitals of the six countries, there are still some problems existing, they are serious loss of business income and expenses, decline in the efficiency of medical services, the rise of asset-liability ratio and irrational drug situation remains grim. It is suggested that government should continue to increase government financial input, adjust charges for medical services, formulate scientific incentive programs, establish dynamic assessment mechanism of the national essential medicine system, and strengthen the publicity and training of rational drug-using.